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Article
Hand Deformities in Patients with Rheumatoid Arthritis

Author: R. R. Merza
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2009 Volume: 8 Issue: 1 Pages: 27-32
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Objective To estimate the types of hand deformities in patients with rheumatoid arthritis (RA). Methods: A group of 100 patients who had been admitted to the department of rheumatology and rehabilitation center in Sulaimany general hospital and those who had been attended to the rheumatology and rehabilitation center between June 2006 and January 2007 were included in this study.86% were females and 14% were males . Patients who had undergone articular surgery and patients below 16 years had been excluded. Results Hand deformities recorded in 47% of cases. The frequency of deformities was as follow; swan neck deformity (48.90%), boutonniere deformity (43.04%), Z deformity(59.5%), ulnar deviation of the metacarpophalangeal joints (MCPJ) (78.7%), radial deviation of the wrist (91.48%), subluxation of the wrist (27.6%), and subluxation of the MCPJ(36.17%).There was a significant correlation between disease duration and development of deformities,other factors that had been studied but had no effect on the development of deformities were rheumatoid factor positivity ;occupation of the patients ;effect of weather;and geographical distribution of the patients. Conclusion Rheumatoid arthritis is an important disease that affects the hands and cause deformities. Understanding these deformities is necessary for the proper management of these patients. This study is representative for RA related hand deformities and factors that contribute to their development.


Article
Rheumatoid Arthritis of the Temporomandibular Joint, A Clinical and Radiographical Study

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Abstract

To determine the extent of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis compared with a matched control group. And to evaluate the correlation between clinical findings and radiographical findings.The studied sample comprised 50 patients with rheumatoid arthritis, age ranged from 18 to 72 years with the mean age of 40.98 (± 13.67.The control group consisted of 63 subjects age–matched non rheumatic patients: Each patient was informed about the purpose of the investigation and that it would include questionnaire, clinical and radiographical examinations. The radiographic examination was done by using double TMJ lateral panoramic technique.It was found that 64% of RA patients complained of two or more clinical signs and symptoms compared with 44% of the control group ,the difference was statistically significant (P< 0.05), the most important clinical findings were pain on palpation and on opening and closing, crepitation, limitation of jaw opening and morning stiffness, difference were statistically significant (P< 0.05). Among the clinically involved subjects in study RA group 28 subjects (56%) had bilateral involvement, 3 subjects (6%) had right side involved and 1 subject (2%) had only left side involvement. The radiographic involvement of TMJ was found in 16 subjects (32.0 %) of the study group compared with 1subject (1.6 %) of the control group. There is a highly statistically significant difference between the study group and the control group (P< 0.05); the most common radiographical finding was erosion. Complete condylar destruction was found in 1 patient which resulted in anterior open bite. Among involved cases 11 subjects (22%) had bilateral involvement, 5 subjects (10%) had unilateral involvement (3subjects (6%) had left side involved and, 2 (4 %) subjects had only right side involved. There was no correlation between clinical and radiographic find ings. There was correlation between the extent of radiographical findings and duration of Rheumatoid Arthritis p value (P< 0.05).The clinical and radiographic findings were more common in RA group than in control individual. The clinical and radiographic findings are not always bilateral in TMJs of patients withrheumatoid arthritis.


Article
Carotid Intima-Media Thickness in Rheumatoid Arthritis Detected by Doppler Ultrasound

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Abstract

Background: The excess mortality associated with rheumatoid arthritis is largely due to cardiovascular disease. Rheumatoid arthritis is of primary importance in atherogenesis. The intima-media thickness of extracranial carotid arteries is a measurable index of the presence of atherosclerosis.Objective: To assess carotid intima-media thickness in rheumatoid arthritis by Doppler ultrasound.Methods: Fifty two Iraqi patients with rheumatoid arthritis were studied and compared with another fifty two, healthy individuals matched for age and sex as a control group. Full history was taken and complete clinical examination was done for all individuals in both groups. Rheumatoid arthritis diagnosis was based on The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Carotid intima-media thickness was measured by Doppler ultrasound.Results: There was a significant increase in the frequency of increased carotid intima-media thickness among individuals with rheumatoid arthritis (44.2%) compared to healthy control group (3.8%) (P=0.000001).Conclusion: Increased carotid intima-media thickness occurs in high frequency in rheumatoid arthritis.


Article
Proinflammatory cytokines profile in patients with Rheumatoid arthritis

Authors: Shahlaa M.Saleh* PhD --- Jabbar R. Zangor** PhD جبار رسن زنكور
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 1 Pages: 57-59
Publisher: Baghdad University جامعة بغداد

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Abstract

Background:Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immunesystem to attack the joints. It is a disabling and painful inflammatory condition, which can lead tosubstantial loss of mobility due to pain and joint destruction. RA is a systemic disease, often affectingextra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles.Patients and Methods: Enzyme immunoassay for Determination of human TNF- , IL-1 and GM-CSFin serumsamples from50 patients with a diagnosis of rheumatoid arthritisResults: of cytokines showed a significant increase in TNF-alpha, IL-1 beta and GM-CSF in patientswith rheumatoid arthritis (70.98 12.08) pg/ml,(238.6 116.4)pg/ml and (96.1 12.08)pg/ml respectively.When compared with the control group (7.0 3.09)pg/ml, (15.4 3.8)pg/ml and (6.8 3.03)pg/mlrespectively.Conclusion: Increased serum levels of proinflammatory cytokine such as TNF- , IL-1 and GM-CSFprobably play important role in driving inflammatory process and promoting joint destruction inrheumatoid arthritis. Regulation of these cytokines is a crucial importance in the RA disease showingpleiotropic actions and many different targets.Keywords: Rheumatoid arthritis, TNF- , IL-1 and GM-CSF.


Article
Frequency of Antineutrophil Cytoplasmic Antibodies (ANCA) in Some Autoimmune Diseases

Authors: Husam M. Abbas --- Falah S. Manhal
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2009 Volume: 18 Issue: 2 Pages: 55-60
Publisher: Baghdad University جامعة بغداد

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Abstract

Anti-Neutrophil Cytoplasmic Antibodies (ANCA) are a heterogeneous group of autoantibodies with a broad spectrum of clinically associated diseases. The diagnostic value is established for Proteinase 3 (PR3)-ANCA as well as Myeloperoxidase (MPO)-ANCA. To estimate the frequency of anti-neutrophile cytoplasmic antibodies (ANCA) in sera from a group of Iraqi patients with some autoimmune diseases compared with a healthy control group. Serum samples were collected from one hundred patient, 47 males and 53 females; with age range of 16-70 years; 20 specimens from patients with systemic lupus erythematosus (SLE), 30 from patients with ulcerative colitis (UC), and 50 from patients with rheumatoid arthritis (RA). A group of 40 apparently healthy blood donors was included as controls. ANCA were checked using enzyme-linked immunosorbent assay (ELISA). Positive ANCA was detected in sera of 18 (18%) patients with autoimmune disorders. Anti-PR3 was detected in 6 (12%) patients with RA, and in 4(13.4%) patients with UC. Anti-MPO was detected in 3(6%) patients with RA and in 5(16.6%) patients with UC. All serum samples of patients with SLE showed negative ANCA. There were no ANCAs detected in sera from healthy individuals. Mean of serum anti-PR3 (U/ml) among the studied groups was 2.057 in RA, 2.209 in SLE, and 2.283 in UC, and 1.739 in control group. Statistical analysis revealed that differences in the anti-PR3 between RA, UC and controls were highly significant (P > 0.01), whereas just significant with SLE (P> 0.05). Mean of serum of anti-MPO (U/ml) among the studied groups was 0.711 in RA, 0.695 in SLE, and 1.170 in UC, and 0.652 in control group. Statistical analysis revealed that the differences in the anti-MPO between RA and SLE, controls were non significant (P < 0.05), whereas highly significance with UC (P> 0.01).It was concluded that ANCA markers might play a role in the inflammatory process and they are important factors for the clinical course, and prognosis in the patients with autoimmunity. However, ANCA in autoimmune disorders must be interpreted cautiously with particular attention paid to laboratory technique, the size, age and genetic background of the populations studied.

الأجسام السايتوبلازمية المضادة للخلايا المتعادلة هي مجموعة مختلفة من الاجسام الذاتية ذات طيف واسع من الامراض المرتبطة سريريا .تم اجراء هذه الدراسة للفترة من تشرين الثاني 2006 لغاية شباط 2007 لغرض تقدير نسبة تكرار الاجسام السايتوبلازمية المضادة للخلايا المتعادلة (ANCA) في أمصال مجموعة من المرضى العراقيين المصابين ببعض الأمراض ذاتية المناعة مقارنة بالمجموعة الضابطة للأصحاء . تم جمع 100 عينة مصل من المرضى (47 ذكور و 53 أناث بمعدل عمري 16-70 سنة) ، 20 عينة من المصابين بداء الذئاب الحماموي المجموعي ، و30 من المصابين بالتهاب القولون التقرحي ، و50 عينة من المصابين بالتهاب المفاصل الرثوي . جمعت 40 عينة مصل من بعض المتبرعين الأصحاء في مصرف الدم كمجموعة ضابطة . تم التحري عن وجودANCA باستخدام تقنية المقايسة المناعية الإنزيمية (ELISA) . تم تشخيص هذه الاجسام المضادة في 18 (18%) من كل المرضى . ظهر anti-PR3 في 6 (12%) من المصابين بالتهاب المفاصل الرثوي وفي 4(13.4%) في مرضى التهاب القولون . ظهر anti-MPO في 3 (6%) من مرضى التهاب المفاصل الرثوي ، و (16.6%)5 من مرضى التها ب القولون. كانت النتائج سالبة في داء الذئاب الحماموي المجموعي. لم تظهر هذه الاجسام في المجموعة الضابطة . ظهر من خلال هذه الدراسة ان متوسط anti-PR3 (وحدة / سم 3) بين المجاميع التي درست كان 2.057 في التهاب المفاصلالرثوي ، 2.209 في داء الذئاب الحماموي المجموعي ، و 2.283 في التهاب القولون التقرحي ، و1.739 في المجموعة الضابطة . أظهر التحليل الإحصائي بان الاختلاف في anti-PR3 بين التهاب المفاصل والتهاب القولون التقرحي مقارنة بالمجموعة الضابطة كان معنويا بشكل عال P) < 0.01 ) ، في حين كان الاختلاف معنويا فقط في داء الذئاب P) < 0.05 ) . ظهر كذلك ان متوسط anti-MPO (وحدة / سم 3) كان 0.711 في التهاب المفاصل ، و 0.695 في داءالذئاب الحماموي ، و 1.170 في التهاب القولون التقرحي ، و 0.652 في المجموعة الضابطة . ظهر كذلك ان الاختلاف في النتائج بين التهاب المفاصل وداء الذئاب الحماموي ومجموعة السيطرة كان غير معنوي P) > 0.05 ) في حين كان الاختلاف معنويا بشكل عال مع التهاب القولون التقرحي P) < 0.01 ) . يستنتج من هذه الدراسة بان الأجسام السايتوبلازمية المضادة للخلايا المتعادلة ((ANCA قد تلعب دورا في العملية الالتهابية وتحديد المسار السريري ومصير المرضى المصابين بامراض المناعة الذاتية . ولكن وجود هذه الاجسام المضادة يجب ان يشخص بحذر في امراض المناعة الذاتية مع تركيز الانتباه على تقنية الفحص و عدد واعمار المرضى وخلفيتهم الوراثية.


Article
Cytokine Profile in Patients with Rheumatoid Arthritis

Author: Falah S. Manhal* PhD د. فلاح سالم منهل
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 4 Pages: 433-436
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary:Background: Cytokines produced by inflammatory cells play a pivotal role in synovial inflammation and joint destruction in rheumatoid arthritis.Patients and Methods: The cytokine serum levels were measured by EASIA (Enzyme amplified sensitivity immunoassay) in sera from 50 RA patients, and 40 healthy donors. Cytokine levels were compared in different RA subpopulations (positive or negative rheumatoid factor (RF), long term or recent onset disease, high or low disease activity). In addition, the possible association with other demographic and clinical parameters (gender, age, etc) was also analyzed. Results: It was demonstrated that IL-2, IL-6 and IFN-δ levels were elevated in serum samples of RA patients as compared with apparently healthy controls. Maximum elevation of TNF-α was recorded in a few number of patient's sera. There were non significant differences between control and RA patient groups in serum TNF-α level. Conclusions: Assessing the serum IL-2, IL-6, IFN-δ and TNF-α levels may be helpful in the confirmation of the RA activity. Due to the chronic course of this disease, other inflammatory markers must be identified in order to provide early therapeutic strategies to these patients.Key words: Rheumatoid Arthritis, Interleukine-2, Interleukine-6, Tumor Necrosis Factor- α, Interferon- δ.

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